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Inguinal hernia in boys

Inguinal (groin) hernias are quite common and are present in around 1 in 6 premature babies. These hernias usually require an operation.

What is a hernia?

A small hole has developed in the muscle in the baby's groin. Some of the intestine is poking out through this hole. We do not know why this happens in some babies but not in others.

Why is an operation needed?

The intestine in the hernia usually moves in and out of the abdomen quite easily. Sometimes the intestine may get stuck in the hernia leading to blockage of, and possibly damage to the intestine or to the blood vessels to the testicle. If this happens emergency surgery may be needed and the intestine or testicle may be damaged. We will plan to fix the hernia before this can happen.

Where will the operation take place?

Your baby will be admitted to the Neonatal Unit at the Princess Anne Hospital, Southampton on the day of surgery.

If your baby is still in a newborn unit at another hospital he will be transferred directly to the Princess Anne Hospital. If your baby is at home you will receive details of where and when to bring your baby to us. You will also receive instructions as to when your baby should stop milk feeds prior to surgery.

However you should continue giving your baby water until you arrive at the Neonatal Unit.

You and your baby will meet both the surgeon and anaesthetist who will explain the operation and the anaesthetic. The operation will be done later that day.

What does the operation involve?

Under anaesthetic a cut will be made in the baby's groin. The hole in the muscle will be repaired with stitches and the skin closed with stitches under the surface. A small dressing may be applied. Local anaesthetic will also be used to numb the skin so as to reduce any pain the baby may feel after waking. Your baby will then be woken up and returned to the high care nursery.

What happens after the surgery?

Occasionally following anaesthetic we know that babies may have a change in their breathing pattern for a few hours, therefore your baby will be observed carefully for signs of apnoea (irregular breathing).

Milk feeds can be given as soon as your baby demands. Usually your baby should be ready to return home or to your local newborn unit the next morning.

What are the complications and risks of the operation?

Surgery is usually very straightforward. However there can be difficulties in small babies. In boys the muscle hole is very close to the blood vessels that go to the testicle.

The hernia itself can damage these blood vessels especially if it gets stuck before surgery but the surgeon must also be careful to protect the vessels as injury to them can affect growth of the testicle in later life.

There is a small risk of injury to the testicle blood vessel to the testicle that may result in poor growth or even loss of the testicle. This might not be obvious until about one year of age.

A wound infection may occur causing redness and discharge of pus a few days after surgery. Antibiotics may be needed.

Bruising at the site of hernia repair can be quite marked and can cause some swelling in a few babies. It usually resolves in a few days.

In rare cases the hernia may come back and a further operation may then be needed. This can even happen within a day or two of the surgery.

Occasionally the testicle may become higher during the first few years of life and an operation is needed to fix the testicle down.

Although most babies only have a hernia on one side, some have a hernia on both sides at the time of surgery. If this is the case in your baby, both hernias will be fixed in one operation. Some babies who only have one hernia can develop another hernia within the next two years, requiring a later operation.

Caring for your Baby after surgery

Your baby can be bathed as normal although water on the wound may sting in the first two days. If there is any dressing this can be removed at five days and a nurse will arrange this for you.

If there is any redness or discharge from the wound please seek medical advice. You may give your baby paracetamol as prescribed every six hours for 24 – 48 hours.

After care

If you have any concerns please contact us. We will arrange for your baby to be seen by a doctor around 6 weeks after the operation. This will be at the outpatient department in either Southampton or your local hospital.

Disclaimer

University Hospital Southampton NHS Foundation Trust produce guidelines as an aid to good clinical practice. They represent recognised methods and techniques of clinical practice, based on published evidence. The ultimate judgement regarding a particular clinical procedure or treatment must be made by the clinician in the light of the clinical data presented by the patient and the diagnostic or treatment options available. The guidelines issued are not intended to be prescriptive directions defining a single course of management and departure from the local guidelines should be fully documented in the patient's case notes at the time the relevant decision is taken.